The management of infants with tracheo-oesophageal fistula.

Abstract

Our technique of dealing with the problelms associated with repair of tracheooesophageal fistula has been described as we have developed it over the years, This method employs basic principles of paediatric anaesthesia and takes cognizance of the many additional factors which present themselves in this condirtion. These are due primarily to involvement of the respiratory tree in the disease, and the frequent coexistence of prematurity and other life-threatening congenital anomalies. With an incidence variously reported as 1:1,300 to 1:4,500 of live births, it is obvious that the condition is relatively infrequently encountered in the average general hospital. In an operation beset with so many problems and pitfalls, in which meticulous attention to even the most minor detail is essential and which is seen at most six times a year in any but the largest general hospitals or in children’s hospitals, it is essential that for best results the management should be limited to one team, so that avoidable mistakes are not repeated by combinations of different individuals. When one thinks in terms of a team, this must, in addition to surgeon and anaesthetist, include the nurses in the intensive treatment area upon whose skill and acute appraisal of abnormal situations the survival of these infants depends to a large measure in the postoperative period. The paediatricians contribute by their advice on fluid replacement therapy and other non-surgical problems and they regulate the oral feeding regimen until such time as the infants are returned to their primary care during convalescence. Until then, all treatment orders are written by one person only (usually by the surgeon or by his resident under his direct orders), after due consultation with other members of the team. This avoids the confusion arising out of contradictory orders or the omission of others, and ensures that at least one person is completely in the picture at all times of every phase of treatment.